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(Stroke. 2002;33:456.)
© 2002 American Heart Association, Inc.

Original Contributions

Cerebral Protection During Carotid Artery Stenting

Collection and Histopathologic Analysis of Embolized Debris

Annalisa Angelini, MD; Bernhard Reimers, MD; Mila Della Barbera, BSc; Salvatore Saccà, MD; Giampaolo Pasquetto, MD; Carlo Cernetti, MD; Marialuisa Valente, MD; Pietro Pascotto, MD Gaetano Thiene, MD, FESC

From the Department of Pathology, University of Padua Medical School (A.A., M.D.B., M.V., G.T.), and Cardiology Department, Mirano Hospital, Mirano (Venice) (B.R., S.S., G.P., C.C., P.P.), Italy.

Correspondence to Gaetano Thiene, MD, FESC, Department of Pathology, University of Padua Medical School, Via A. Gabelli 61, 35121 Padua, Italy. E-mail cardpath{at}unipd.it

Background and Purpose— Histopathologic analysis was performed to better understand quantity, particle size, and composition of embolized debris collected in protection filters during carotid artery stent implantation.

Methods— Elective carotid stent implantation with the use of a distal filter protection was attempted in 38 consecutive lesions (36 patients) of the internal carotid artery presenting >70% diameter stenosis (mean, 82.1±11.1%). Mean age of the patients was 70.7±7.7 years; 75% were men, and 50% of patients had previous neurological symptoms.

Results— In 37 lesions (97.4%) it was possible to position the filter device, and in all lesions a stent was successfully implanted. The only complication occurring in the hospital and during the 30-day follow-up was 1 death due to acute myocardial infarction. Neurological sequelae did not occur. Histomorphometric analysis was performed on the filters. Presence of debris was detected in 83.7% of filters. The mean surface area of the polyurethane membrane filter covered with material was 53.2±19.8%. Particle size ranged from 1.08 to 5043.5 µm (mean, 289.5±512 µm) in the major axis and 0.7 to 1175.3 µm (mean, 119.7±186.7 µm) in the minor axis. Collected debris consisted predominantly of thrombotic material, foam cells, and cholesterol clefts.

Conclusions— By the use of distal protection filters during carotid artery stenting, it was possible to collect particulate debris potentially leading to distal vessel occlusion in a high percentage of cases. Qualitative analysis of embolized material showed debris dislocated during the percutaneous intervention from atheromatous plaques.

Key Words: angioplasty • carotid arteries • embolism • pathology • stents

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